predominantly inattentive presentation
predominantly inattentive presentation
The client is an 8 year old Caucasian female who appears appropriately developed for her age. Her speech is clear, coherent, and logical. She is appropriately oriented to person, place, time, and event. She is dressed appropriately for the weather and time of year. She demonstrates no noteworthy mannerisms, gestures, or tics. Self-reported mood is euthymic. Affect is bright. Katie denies visual or auditory hallucinations, no delusional or paranoid thought processes readily appreciated. Attention and concentration are grossly intact based on Katie’s attending to the clinical interview and her ability to count backwards from 100 by serial 2’s and 5’s. Insight and judgment appear age appropriate. Katie denies any suicidal or homicidal ideation.
Diagnosis: Attention deficit hyperactivity disorder, predominantly inattentive presentation
Decision Point One
Select what the PMHNP should do:
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-red.pngBegin Wellbutrin (bupropion) XL 150 mg orally daily
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-blue.pngBegin Intuniv extended release 1 mg orally at BEDTIME
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-yellow.pngBegin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
Decision Point Two
Select what the PMHNP should do next:
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-red.pngContinue same dose of Ritalin and re-evaluate in 4 week
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-blue.pngChange to Ritalin LA 20 mg orally daily in the MORNING
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-yellow.pngDiscontinue Ritalin and begin Adderall XR 15 mg orally daily
Decision Point Three
Select what the PMHNP should do next:
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-red.pngMaintain current dose of Ritalin LA and reevaluate in 4 weeks
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-blue.pngIncrease Ritalin LA to 30 mg orally daily
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-yellow.pngObtain EKG based on current heart rate
Decision Point One
https://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6630/09/mm/attention_deficit_hyperactivity_disorder/img/pill-yellow.pngBegin Ritalin (methylphenidate) chewable tablets 10 mg orally in the MORNING
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
Katie’s parents report that they spoke with Katie’s teacher who notices that her symptoms are much better in the morning, which has resulted in improvement in her overall academic performance. However, by the afternoon, Katie is “staring off into space” and “daydreaming” again
Katie’s parents are very concerned, however, because Katie reported that her “heart felt funny.” You obtain a pulse rate and find that Katie’s heart is beating about 130 beats per minute
